Bile Acid Sequestrants
Myalgia The combination of gemfibrozil (Lopid) and rosuvastatin (Crestor) could indicate rhabdomyolysis and should be reported to the provider. Blurred vision is a common side effect of fibric acid derivatives. Rash is a common side effect of fibric acid derivatives. Vertigo is a common side effect of fibric acid derivatives.
A patient is taking gemfibrozil (Lopid) and rosuvastatin (Crestor). The nurse teaches the patient that which side effect should be reported to the health care provider? Blurred vision Rash Myalgia Vertigo
Lopid - Gemfibrozil Tricor - Fenofibrate (Lopid) is a fibric acid derivative.(Tricor) is a fibric acid derivative. Simvastatin (Zocor) is a statin drug. Atorvastatin (Lipitor) is a statin drug. Rosuvastatin (Crestor) is a statin drug.
Fibrates are known by which trade names? Lopid Tricor Zocor Lipitor Crestor
30 minutes before meals Gemfibrozil (Lopid) dosing is done 30 minutes before morning and evening meals. Gemfibrozil (Lopid) is not to be taken after meals. Gemfibrozil (Lopid) is not given 1 hour before meals.
How is gemfibrozil (Lopid) taken with regard to meals? 30 minutes before meals 30 minutes after meals 1 hour before meals 1 hour after meals
Small intestine Bile-acid sequestrants bind to cholesterol in the small intestine. Bile-acid sequestrants bind to cholesterol in the small intestine. Bile-acid sequestrants bind to cholesterol in the small intestine Feces are formed in the large intestine after cholesterol is bound in the small intestine.
The nurse explains to a patient how bile-acid sequestrants work. Where in the body do bile-acid sequestrants bind to cholesterol? Stomach Transverse colon Small intestine Feces
LDL (low density lipoprotein) Bile-acid sequestrants target lowering LDL (low density lipoproteins) Bile-acid sequestrants target lowering LDL (low density lipoproteins) Bile-acid sequestrants target lowering LDL (low density lipoproteins) Bile-acid sequestrants target lowering LDL (low density lipoproteins)
The nurse explains to the patient what component bile-acid sequestrants target. Bile-acid sequestrants lower which lipoprotein? HDL (high density lipoprotein) VLDL (very low density lipoprotein) LDL (low density lipoprotein) Triglycerides
Decrease in triglyceride levels Fibrates primarily decrease the triglyceride levels. Fibrates may lower total cholesterol. Fibrates may decrease LDL cholesterol levels. Fibrates may increase the HDL cholesterol levels.
The nurse is collecting a medication list upon admission and notes that the patient is taking a fibric acid derivative. What is the expected action of the drug? Decrease in triglyceride levels Increase in total cholesterol Increase in LDL cholesterol Decrease in HDL cholesterol
The adult dosage should be twice a day. The adult dosage of gemfibrozil (Lopid) is 600 mg twice a day. The adult dosage of gemfibrozil (Lopid) is given before morning and evening meals. The adult dosage of gemfibrozil (Lopid) is not given via subcutaneous injection. The adult dosage of gemfibrozil (Lopid) is not given via intramuscular injection.
The nurse is ordered to administer gemfibrozil (Lopid) by mouth to a patient every morning. Why does the nurse question the administration of this dose? The adult dosage should be twice a day. The adult dosage should be each evening. The adult dosage is given via subcutaneous injection. The adult dosage is given via intramuscular injection.
30 minutes before the morning and evening meals Dosing for fibric acid derivatives is done 30 minutes before the morning and evening meals. Dosing for fibrates is twice a day. Dosing for fibric acid derivatives is not done after the morning and evening meals. Dosing for fibrates is twice a day
The nurse is providing discharge education to a patient in the telemetry unit who has just been prescribed a fibric acid derivative. The nurse instructs the patient to take the medication in what manner? Daily in the evening 30 minutes after the morning and evening meals 30 minutes before the morning and evening meals Daily in the morning
Gallbladder disease Fibrates are contraindicated in patients with a known preexisting gallbladder disease. A medical history of myocardial infarction is not a contraindication for the use of fibrates. Fibrates are not contraindicated for patients with a history of congestive heart failure. Fibrates are contraindicated in patient with significant renal dysfunction, not kidney stones.
The nurse is reviewing the medication orders for a new patient and notes that the physician has prescribed a fibric acid derivative. Which documented medical history would cause the nurse to question this order? Myocardial infarction Congestive heart failure Gallbladder disease Kidney stones
Colesevelam (Welchol) has fewer patient side effects. Colesevelam (Welchol) may be taken with statins, digoxin, and warfarin. Less constipation, bloating, cramping, and flatulence is reported. Patients with hyperlipidemia are frequently taking statins, digoxin, and/or warfarin. Less interference with these being absorbed is easier for patient medication routines. Colesevelam (Welchol) is dosed once or twice a day with a meal. Colesevelam (Welchol) is to be taken with meals in order to bind with bile in the gastrointestinal tract. Colesevelam (Welchol) is the only bile-acid sequestrant which does not significantly block absorption of important fat-soluble vitamins (A, D, E, and K).
The nurse prepares to administer colesevelam (Welchol) to a patient. The nurse knows that which statement is true regarding Colesevelam (Welchol)? Colesevelam (Welchol) has fewer patient side effects. Colesevelam (Welchol) is dosed once per week. Colesevelam (Welchol) may be taken with statins, digoxin, and warfarin. Colesvelam (Welchol) may be taken on an empty stomach. Colesevelam (Welchol) reduces absorption of fat-soluble vitamins (A, D, E, and K).
Bile-acid sequestrants powders are difficult to mix in liquids. Lifestyle management is important, in addition to bile-acid sequestrants, in the treatment of hyperlipidemia. Maintaining good bowel habits facilitate the effectiveness of bile-acid sequestrant treatment. Bile-acid sequestrants are not soluble in water; therefore, patient compliance may be reduced with the powder form of bile-acid sequestrants. Exercise and a diet reducing saturated fats can more actively involve patients in their choices of lifestyle management. Bile-acid sequestrants bind with cholesterol in the small intestine and are excreted in the feces. Bile-acid sequestrants are considered adjunctive therapy for modifying cholesterol. Bile-acid sequestrants alone average a 20% reduction in LDL (low density lipoproteins). Combined with a statin LDL cholesterol can be reduced up to 50%.
The nurse reviews the physician's order for a bile-acid sequestrant to be administered to a new patient. Which statements are specific to bile-acid sequestrant medications? Bile-acid sequestrants powders are difficult to mix in liquids. Bile-acid sequestrants are the main drug of choice for treating hyperlipidemia. Lifestyle management is important, in addition to bile-acid sequestrants, in the treatment of hyperlipidemia. Bile-acid sequestrants are not combined with statin medications. Maintaining good bowel habits facilitate the effectiveness of bile-acid sequestrant treatment.
Statin drugs Oral anticoagulants Combining gemfibrozil (Lopid) with a statin is not recommended due to increased risk of rhabdomyolysis. Gemfibrozil (Lopid) can enhance the action of oral anticoagulants, thus careful dosing of warfarin (Coumadin) is required. Antibiotics are not enhanced by the use of fibrates. Antihypertensive agents may be combined with fibric acid derivatives. Insulin may be used with fibrates.
The nurse should instruct the patient to be aware of what medication interactions when taking a newly prescribed fibrate? Antibiotics Statin drugs Antihypertensive agents Insulin Oral anticoagulants
LDL (low density lipoproteins) HDL (high density lipoproteins) LDL (low density lipoproteins) carries 50%-60% of cholesterol in the blood with increased risk for CAD (coronary artery disease). Lowering LDL is a positive response of colesevelam (Welchol). HDL (high density lipoproteins) removes cholesterol from the bloodstream and delivers it to the liver for excretion in the bile. Rising HDL values is a positive response of colesevelam (Welchol). Colesevelam (Welchol) does not alter thyroid function. Colesevelam (Welchol) does not alter hemoglobin values. Colesevelam (Welchol) does not alter platelet counts.
The nurse should review which lab values to monitor the therapeutic response to colesevelam (Welchol)? LDL (low density lipoproteins) TSH (Thyroid stimulating hormone) Hemoglobin HDL (high density lipoproteins) Platelet count
"Bile-acid sequestrants cannot be attacked by digestive enzymes." Bile-acid sequestrants do not attack digestive enzymes because they are biologically inert. Bile-acid sequestrants have no known effect on stomach emptying. Bile-acid sequestrants are used primarily as adjuncts to statin drugs for lowering LDL (low density lipoproteins). Bile-acid sequestrants are insoluble in water.
The patient asks the nurse about the properties of bile-acid sequestrants. How should the nurse respond? "Bile-acid sequestrants cannot be attacked by digestive enzymes." "Bile-acid sequestrants delay stomach emptying." "Bile-acid sequestrants are first line drugs to lower LDL." "Bile-acid sequestrants are soluble in water."
Several days The onset of action is several days in fibric acid derivatives, not one to two hours, one day or several weeks.
The physician has written an order for fibrates to be initiated for a patient in the telemetry unit. How long is the onset of action of this medication? One to two hours One day Several days Several weeks
1-2 hours Peak plasma concentration occurs in 1-2 hours. Peak plasma concentration does not occur in 15-30 minutes, 30-60 minutes or 2-3 hours.
The physician has written an order to start fibrates prior to discharge. After giving the first dose, how long does the nurse expect to wait for peak plasma concentration to occur? 15-30 minutes 30-60 minutes 1-2 hours 2-3 hours
Nausea Headache Decreased urine output Nausea, headache & decreased urine output are common side effects of fibric acid derivatives. Liver function tests may show an increase in liver enzymes with fibrates. Tinnitus is not an expected side effect of fibric acid derivatives.
What are the expected side effects of fibric acid derivatives? Select all that apply. Nausea Headache Decreased urine output Decreased liver enzymes Tinnitus
Triglyceride levels - Fibric acid drugs primarily affect the triglyceride levels. Total cholesterol- Fibric acid drugs may have an effect on lowering total cholesterol but this is not the primary action. LDL cholesterol - Fibric acid drugs may lower the LDL cholesterol but primarily affect triglyceride levels. HDL cholesterol - Fibric acid drugs may raise the HDL cholesterol but this is not the primary action.
What do fibric acid derivatives primarily affect? Triglyceride levels-Correct Answer Total cholesterol LDL cholesterol HDL cholesterol
Gastrointestinal discomfort Bile-acid sequestrants bind with bile in the gastrointestinal tract and are not systemically absorbed. This causes GI discomfort including nausea, constipation, and flatulence. Bile-acid sequestrants have no known effect on vision, balance or sleep patterns.
What is a side effect of bile-acid sequestrants that requires patient education? Blurred vision Increased falls Gastrointestinal discomfort Insomnia
Gastrointestinal disturbances A discussion with the nurse about constipation, bloating, cramping, and flatulence can reassure the patient and increase medication compliance. Night sweats are not a known side effect of bile-acid sequestrants. Dizziness is not a known side effect of bile-acid sequestrants. Tingling in hands and feet is not a known side effect of bile-acid sequestrants.
Which adverse effect of bile-acid sequestrants does the nurse teach the patient about? Night sweats Gastrointestinal disturbances Dizziness Tingling in hands and feet
Nausea Vomiting Constipation Flatulence Constipation is often experienced with bile-acid administration. Nausea, vomiting & Flatulence are sometimes experienced with bile-acid administration. Insomnia is not associated with bile-acid sequestrant administration.
Which are the adverse effects of bile-acid sequestrants? Select all that apply. Nausea Vomiting Insomnia Constipation Flatulence
Lipoprotein lipase Fibrates work by activating lipoprotein lipase, an enzyme responsible for breakdown of cholesterol. Fibrates do not work through the activation of very low density lipoprotein. Fibrates do not work through the activation of high density lipoprotein.Fibrates do not work through the activation of low density lipoprotein. Fibrates do not work through the activation of high density lipoprotein.
Which component must be activated in order for fibrates to work? Very low density lipoprotein Lipoprotein lipase Low density lipoproteins High density lipoproteins
Fibrate Gemfibrozil (Lopid) is a fibrate, also known as a fibric acid derivative. Gemfibrozil (Lopid) is not a statin drug. Gemfibrozil (Lopid) does not belong in the niacin class. Gemfibrozil (Lopid) is not a neutraceutical drug.
Which drug class is documented when a patient's medication history includes gemfibrozil (Lopid)? Fibrate Statin Niacin Neutraceutical
LDL (low density lipoproteins) HDL (high density lipoproteins) LDL (low density lipoproteins) carry 50%-60% of cholesterol in the blood stream with increased risk for CAD (coronary artery disease). Lowering LDL levels is a positive response. HDL (high density lipoproteins) remove cholesterol from the bloodstream, deliver it to the liver for excretion in the bile. Raising HDL levels is a positive response. The WBC (white blood cell count) does not measure blood lipids.Bile-acid sequestrants do not alter thyroid function.HDL (high density lipoproteins) remove cholesterol from the bloodstream, deliver it to the liver for excretion in the bile. Raising HDL levels is a positive response.
Which lab results will the nurse monitor to assess the therapeutic response for a patient receiving bile-acid sequestrants? Select all that apply. WBC (white blood cell count) LDL (low density lipoproteins) TSH (thyroid stimulating hormone) HDL (high density lipoproteins) Urinalysis
Prothrombin time Liver function test Prothrombin time must be reviewed as fibric acid derivatives may cause prolonged levels. Liver function tests must be reviewed and monitored with fibrates as the drug can cause an increase in enzyme levels. Metabolic panels may be reviewed, but is not an urgent need in patients with fibrates.Lipid panels should be monitored with fibrate use, but is not affected by warfarin (Coumadin).Fibric acid derivatives have an effect on the complete blood panel, but is not urgent prior to administration.
Which laboratory results are reviewed and documented by the nurse prior to the administration of a fibric acid derivative to a patient also taking warfarin (Coumadin)? Prothrombin time Liver function test Metabolic panel Lipid panel Complete blood panel
Separate taking bile-acid sequestrants by one hour before or four hours after taking thyroid hormones. Bile-acid sequestrants bind to and decrease the absorption and hence the effectiveness of Thyroid hormones (Synthroid, Levoxyl) Bile-acid sequestrants need to be taken with a meal, not at bedtime. Bile-acid sequestrants bind to and decrease the absorption and hence the effectiveness of Warfarin (Coumadin). Verbally teaching the patient and family members along with detailed printed instructions increase patient understanding about bile-acid sequestrant medications and compliance.
Which nursing instruction should be given to the patient taking a bile-acid sequestrant? Take bile-acid sequestrants at bedtime. Separate taking bile-acid sequestrants by one hour before or four hours after taking thyroid hormones Warfarin (Coumadin) may be taken at the same time as bile-acid sequestrants. Prescription bottle labels provide all instructions for taking bile-acid sequestrants.
The main response to bile-acid sequestrants is a reduction in LDL (low density lipoproteins). The mechanism of action is binding of bile acids to cholesterol in the intestine creating insoluble cholesterol excreted through the feces. The HDL (high density lipoproteins) does not decline in response to bile-acid sequestrants. VLDL (very low density lipoproteins) may increase in some patients who have high VLDL levels before with bile-acid sequestrants and are therefore not the drug of choice. The therapeutic response to bile-acid sequestrants begins in the first week of therapy and becomes maximal (about a 20% drop) within about a month.
Which statement best describes the response to bile-acid sequestrants? The HDL (high density lipoproteins) declines 10% in the first week of treatment. In patients with high VLDL (very low density lipoproteins), bile-acid sequestrants are a good first drug to consider. The main response to bile-acid sequestrants is a reduction in LDL (low density lipoproteins). The therapeutic response to bile-acid sequestrants begins in the first month of therapy and becomes maximal (about a 35% drop) in about three months.
Colesevelam (Welchol) can help control hyperglycemia in patients with Type 2 diabetes. Colesvelam (Welchol) was FDA (Federal Drug Administration) approved in 2008 for adjunctive therapy of Type 2 diabetes. Colesvelam (Welchol) must be taken with a meal to provide a food bolus in the intestine for the binding action with cholesterol. Colesvelam (Welchol) does not significantly reduce the absorption of warfarin (Coumadin) and may be safely prescribed when needed for anticoagulation therapy. There is no known interaction with OTC (over the counter) cold medications and Colesvelam (Welchol).
Which statement describes a beneficial effect of colesevelam (Welchol)? Colesvelam (Welchol) may be taken on an empty stomach. Warfarin (Coumadin) should not be prescribed for a patient taking Colesvelam (Welchol). Colesevelam (Welchol) can help control hyperglycemia in patients with Type 2 diabetes. OTC (over the counter) cold medications are more effective when taken with Colesvelam (Welchol).
Bile-acid sequestrants are biologically inert Bile-acid sequestrants do not initiate a response or interact when introduced to biological tissue. Bile-acid sequestrants are not attacked by digestive enzymes because they are biologically inert. Bile-acid sequestrants are insoluble; therefore, they pass directly in the feces without retention in the intestines. Bile-acid sequestrants have no known effect on the urinary tract.
Which statement describes the properties of bile-acid sequestrants? Bile-acid sequestrants are biologically inert. Bile-acid sequestrants can be attacked by digestive enzymes. Following oral administration, bile-acid sequestrants need to be retained in the intestines for a week before being excreted in the feces. Bile-acid sequestrants may cause urinary incontinence.
Bile acids secreted into the intestines are reabsorbed and reused. The bile-acid sequestrants bind cholesterol in the gastrointestinal tract. The bile-acid sequestrants result in an increase in the number of LDL receptors on the liver surface The normal bile acids are reabsorbed from the intestines and reused by the liver. The bile-acid sequestrants bind cholesterol in the gastrointestinal tract and prevent the resorption of the bile from the small intestine. This insoluble bile, bound to cholesterol is excreted in the feces.Insoluble bile cannot return to the liver, which causes the liver to compensate for the loss of cholesterol by increasing the number of LDL receptors on its surface. Bile is excreted via the gastrointestinal tract not kidney. Bile-acid sequestrants usually lower LDL cholesterol by 10%-20%, not increase.
Which statement(s) describe(s) the pharmacodynamics of bile-acid sequestrants? The bile-acid sequestrants excrete bile in the urine. Bile acids secreted into the intestines are reabsorbed and reused. The bile-acid sequestrants bind cholesterol in the gastrointestinal tract. The bile-acids sequestrants usually raise LDL cholesterol by 10%-20%. The bile-acid sequestrants result in an increase in the number of LDL receptors on the liver surface
Bile acids in the intestine are normally reabsorbed and reused. Bile-acid sequestrants form an insoluble complex with bile acids, which prevents reabsorption and accelerates their excretion. Bile acids in the intestine are normally reabsorbed and reused in the liver. Bile-acid sequestrants form an insoluble complex with bile acids, which prevents reabsorption and accelerates their excretion. Bile acids are secreted from the liver into the intestine. The liver replenishes bile acid from cholesterol in LDL (low density lipoprotein) cells in the plasma. The liver has specific receptor sites for LDL (low density lipoproteins) cholesterol which reduces the total LDL cells in plasma circulation.
Which statements are correct regarding the pharmacodynamics of bile-acid sequestrants? Bile acids are secreted from the pancreas. Bile acids in the intestine are normally reabsorbed and reused. Bile-acid sequestrants form an insoluble complex with bile acids, which prevents reabsorption and accelerates their excretion. The liver replenishes bile acid from cholesterol in HDL (high density lipoprotein) cells in the plasma. The liver has receptor sites for HDL (high density lipoproteins) cholesterol.